Remplacement total de l’articulation temporo-mandibulaire par prothèse

Abstract

Summary Introduction The temporomandibular joint (TMJ) may be the location for tumoral, post-traumatic, degenerative, inflammatory, or congenital diseases requiring a prosthetic replacement. We present a technical note for total TMJ replacement with a Biomet ® Microfixation prosthesis (Jacksonville, FL, USA). Technical note The preoperative data includes dental panoramic X-ray, MRI of the TMJ, and CT-scan (or cone beam) of the facial skeleton. The last two mentioned examinations allow three-dimensional reconstructions and stereo-lithographic models required for surgical planning. The prosthetic device includes a temporal ultra-high density polyethylene component and a mandibular chrome-cobalt-molybdenum-titanium alloy component; in case of allergy the prosthesis is made in titanium. These components may be standard size or custom made. The surgery requires through two common surgical approaches: pre-auricular and sub-mandibular. When a custom-made prosthesis is used, osteotomies are performed using surgical guides provided by the manufacturer. After intermaxillary fixation, the various prosthetic components are positioned and fixed with specific titanium screws, 2 mm (temporal component) and 2.7 mm (mandibular component) in diameter. The occlusion and prosthesis functionality are tested after releasing the intermaxillary fixation. Soft food intake is recommended for 21 days and physiotherapy is initiated on the second postoperative week for at least 1 year. Discussion The total replacement technique with a Biomet Microfixation ® prosthesis is a simple procedure. It allows recovering a good articular function and relieves the patient.